Stateline: Setting Up Health Insurance Exchanges, States Face Big Decisions Governors have deep differences over national health care reform, but when it comes to so-called insurance exchanges - a centerpiece of the sprawling new federal law - nearly every state is moving ahead with implementation (Vestal, 1/26).

The Sacramento Bee: Emergency Regulation Gives California Teeth To Enforce Health Insurance Payouts Insurance Commissioner Dave Jones has won approval for an emergency regulation that gives him authority to enforce a new federal rule requiring health insurers to spend at least 80 percent of premiums on medical care. Until now, state regulators were limited to enforcing a 70 percent "medical-loss ratio." But as of Jan. 1, California's standard has been superceded by the federal health care law that requires insurers to comply with the higher level. Under the new law, insurers who fail to comply with the minimum medical-loss ratio this year must issue refunds next year to customers who buy insurance on their own (Calvan, 1/26).

Modern Healthcare: Calif. Official Vows To Enforce Spending Mandate California Insurance Commissioner Dave Jones announced he now has the authority to enforce how health plan premium dollars are spent by insurance companies. The federal health reform law mandated that, starting Jan. 1, insurers must spend at least 80% of every member premium dollar for the individual market on medical care or quality-improvement activities. ... Jones requested an emergency regulation to enforce this provision, and the Office of Administration Law has granted that request (Vesely, 1/25).

The New York Times: For A Medicaid Cost-Cutter From Wisconsin, A More Complicated Job In New YorkWisconsin is not New York, where [Jason] Helgerson, 39, now has the task of reining in the state's troubled Medicaid program. Gov. Andrew M. Cuomo recruited him to find billions of dollars in savings to help close the state's more than $9 billion budget gap in the next fiscal year (Kaplan, 1/25).

Bloomberg: Christie Says Medicaid Will Be Biggest Challenge In Next New Jersey Budget New Jersey Governor Chris Christie said Medicaid costs will be the largest challenge in the state's next budget, which he will propose in less than a month. The state's Medicaid program, which provides health care for the poor, faces a $1.4 billion deficit because of the loss of assistance from the federal government and the requirement to maintain services at levels mandated by the U.S., Christie said (Dopp, 1/25).

The Arizona Republic: Brewer Submits Request For Medicaid Waiver Arizona on Tuesday became the first state to officially ask the federal government's permission to eliminate Medicaid coverage for hundreds of thousands of low-income residents in an effort to close a massive budget gap. In a four-page letter to Health and Human Services Secretary Kathleen Sebelius, and an accompanying 19-page proposal to the Centers for Medicare & Medicaid Services, Gov. Jan Brewer says she needs relief from a federal mandate requiring states to maintain current eligibility levels (Rough, 1/25).

The Boston Globe: Insurers Say Merger Would Cut Health Costs The leaders of Harvard Pilgrim Health Care and Tufts Health Plan said yesterday joining forces will give them the scale to expand across New England and beyond at a time when sweeping changes in the health care industry demand larger and more competitive players. Tufts chief executive James Roosevelt Jr. and his Harvard Pilgrim counterpart, Eric H. Schultz, signed a memo of understanding to explore a merger and, in separate meetings with their employees, outlined how combining the state's second- and third-largest health plans would help provide improved medical care at lower cost (Weisman and Lazar, 1/26).

Kansas Health Institute: Legislator Revives Constitutional Amendment Opposing Federal Health Law The chair of the House Health and Human Services Committee said she is close to reintroducing a proposed constitutional amendment aimed at blocking implementation of the federal health reform law in Kansas (Ranney, 1/25).

Health News Florida: Medicaid Battle Ready To Flare Again As a key state House committee gets ready today to start tackling Medicaid reform, activist groups are preparing for a debate that will last throughout the 2011 legislative session (1/25).

Health News Florida: Pharmacies Fight Mail-Order Drugs Community pharmacies are challenging the constitutionality of an eleventh-hour legislative decision last year that could spur thousands of chronically ill Medicaid patients to use mail-order drugs (Saunders, 1/26).

The Des Moines Register: House GOP Rift Stalls Effort To Narrow Iowa Abortion Laws An ideological difference among Iowa House Republicans has sidelined their push to narrow the state's abortion laws and keep a Nebraska doctor from opening a Council Bluffs abortion clinic. The disagreement: Two key Republicans say the bill does not go far enough. Instead of stopping abortion after 20 weeks, they want to enact a law to end all abortions in Iowa (Clayworth, 1/26).

Minnesota Public Radio: Minn's Med Tech Companies Hope For Better 2011 Last year was turbulent and often disappointing for the medical technology industry, one of Minnesota's most important. The big med tech companies based in the state begin to report their latest earnings this week, as well as their outlook for 2011. Even if the financial results of these companies improve, the medical technology sector itself faces ongoing challenges. There's an upcoming tax on devices in the federal health overhaul (Moylan, 1/25).

California Healthline: Health Cuts Raising Seniors' Hackles [Wednesday's] subcommittee hearing is the first time the Legislature will be discussing some of the $1.7 billion in proposed Medi-Cal cuts. That includes elimination of the Adult Day Health Services program, which Democratic Gov. Jerry Brown hopes would save the state $177 million of general fund money. Lydia Missaelides, executive director of the California Association for Adult Day Services, doesn't believe it (Gorn, 1/25).

San Francisco Chronicle: Health Spending Isn't Helping State's Inmates A federal receiver appointed to control mismanagement of inmate health care dramatically increased spending in California's prisons but has so far failed to significantly improve conditions for sick and injured convicts, a state Assembly committee has concluded (Lagos, 1/26).

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.